Healthcare Provider Details

I. General information

NPI: 1659291243
Provider Name (Legal Business Name): JACOB KWAST CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 FULTON ST E
ADA MI
49301-8107
US

IV. Provider business mailing address

3071 NEWMARKET DR APT E
ROCKFORD MI
49341-8976
US

V. Phone/Fax

Practice location:
  • Phone: 616-278-8511
  • Fax:
Mailing address:
  • Phone: 616-278-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB MICHAEL KWAST
Title or Position: CEO
Credential: D.C
Phone: 616-278-8511